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ABS QE > ABS QE > Flashcards

ABS QE Flashcards

1
Q

what is the composition of fluid in chlyous acities?

A

High TG(>110 or x2 plasma level, Low cholesterol, leukocytosis with lymphocytic predominance and negatie cultures

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2
Q

Top 2 MC methods of injury in old ppl?

A

1) falls 2) MVC

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3
Q

what enzyme cleared fastest in acute pancreattis?

A

Amylase < 48 hrs

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4
Q

What day does max collagen accumulation occur?

A

day 21 Type I collagen right before phase three begins and degredation occurs

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5
Q

Epidermal tumor with peripheral pallisading of nuclei with stromal retraction. Diag?

A

Basal cell (most common cancer overall

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6
Q

Diag Malignant degeneration of epithelial cells with differentiation toward keratin

A

SCC

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7
Q

Absolute CI to stenting across the left subclavian artery?

A

1)Aberrent/ Left dominant vertebral, 2) CABG using IMA (cardiac ischemia) 3) LUE AVF

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8
Q

1cm skin lesion concerning for melanoma on forearm NSM?

A

Full thickness narrow margin excision biopsy with 1 to 3mm of nomral skin and fat (punch bx if large > 2cm or sensative area

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9
Q

melanoma stage if postive LN?

A

Stage III

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10
Q

Most common gene mutation in CRC?

A

APC

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11
Q

which gene mutation would alter tx of metastatic colon ca?

A

KRAS (unable to use anti-EGFR targeted therapy)

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12
Q

Positive DPL in blunt trauma?

A

10 mL of gross blood, bacteria, bile, food particles; or infusate >100,000 RBCs or >500 WBCs.

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13
Q

Tx for metastatic carcinoid?

A

Debulking for symptoms and somatostatin anlaog (lanreotide)

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14
Q

Surgical approach to access peroneal artery for bypass ?

A

infapopliteal approach medial or laterally (requires fibulectomy)

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15
Q

what are the borders and nerve contents in triangle of pain?

A

Medially: spermatic vessels, laterally and sup ileopubic tract (IL).. (Contains femoral branch of genitofemoral and lateral cutaneous n thigh)

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16
Q

When to do ppx thyroidectomy with CLND in MEN2A vs B

A

B: before 1 yr old, A: Before 5 yrs old

B = bad

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17
Q

1.5-cm purple, raised, subcutaneous nodule over his forearm and palpable axillary lymphadenopathy. Bx large, pale nuclei (with salt and pepper chromatin) and scant cytoplasm. Each cell has whorled paranuclear plaques (Blue cells)

A

Merckle cell ca

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18
Q

How to differentiate merckle cell ca from Small cell lung Ca?

A

Both CD 20 +, MCC negative for thyroid transcription factor 1 TTF-1), SCC postiive for both

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19
Q

what are the two primary bile acids synthesized by the liver?

A

Only the primary bile acids (cholic acid and chenodeoxycholic acid) begin with the letter “C.”

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20
Q

MC bacteria to cause lymphangitis?

A

Strep pyogenes

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21
Q

how to diagnose hereditary pancreatitis?

A

x2 1st degree relatives or x3 second degree over 2 generations or positive for cationic trypsinogen gene (PRSS1 AD)

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22
Q

why does elevated ICP cause diplopia

A

6th nerve palsy resulting in LR weakness from brainstem depression

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23
Q

what are 3 main biases of ca screening test

A

1) lead time (clock starts early) 2) Length time (tests find non aggresive cancers 3) self selection

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24
Q

which paralytics undergo hoffman degedation?

A

ataracurium and cisatracurium

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25
Q

Nerve injury resulting ln dec sensation over the posterior-lateral foot and leg following ablation of SSV?

A

Surval Nerve

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26
Q

what defines stage III of pericardial tamponade?

A

Pericardial P approaches LVEDP resulting in cardiac collpase death

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27
Q

2 cm carcinoid in mesentary 22 cm from IC valve causing SBO tx

A

segemental SBR with assoc mesentary with enteroenterostomy (2cm margins)

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28
Q

MC indication for liver trn?

A

Hep C

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29
Q

Tx of x3 < 1cm T1a Gastric NET (carcinoid) w/ elevated gastrin levels??

A

Endoscopic resection if less than 1cm, < 6 nodules, and no muscular invasion. Otherwise antrectomy. Consider source MEN 1 vs atrophic gastritis

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30
Q

Suspicious features on mammography for cancer

A

irregular masses with spiculated margins and high density, and pleomorphic, linear, branching, and segmental calcifications

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31
Q

What population at risk for pressure ulcers?

A

Pysch, depressed patients -> imobility poor nutrition

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32
Q

2nd MC paraneoplastic syndrome associated with thymoma?

A

1) MG 2) Pure red blood cell aplasia

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33
Q

Blood supply to rectal stump in colorectal anastamosis

A

Inferior hemmorhoidal artery (via the internal illiac)

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34
Q

41 yo F with 6cm peripheral to central enhancing liver lesion on CT w/ sxs Diag and Tx?

A

Hemangioma, tx resection (anatomical if central, enucleation if peripheral)

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35
Q

MC congential bleeding disorder and inheritance pattern?

A

Von Willebrand Dz Type I, AD (quan def of WvF -> instability of factor 8-> dec VIII and vWF -> Coagulapathy

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36
Q

Fastest way to increase oxygenation in intubated patient?

A

Increase FIO2, other way would be inc PEEP takes hours

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37
Q

MC RF for SCC of the lower lip

A

UV radiation (sunglight)

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38
Q

Concerning factors for breast can discharge

A

unilateral, clear or bloody discharge, guiac postiive

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39
Q

Diag & tx of 1.5 cm thyroid mass with microcalcifications ?

A

Non diff thyroid ca (papillary) need total thyroidectomy central neck dissection NOT necessary unless clinically positive nodes

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40
Q

what are the 3 specific site PTH works to inc Ca++ absorb?

A

1) Kidney @ Distal convoluted tubule 2) Stimulates osteoclasts in bone 3) Activiation of Vita D -> Inc ca gut absorption. Also stim phos trashing at PCT

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41
Q

Hcl Burn initial treatment stable airway no systemic signs of hypoCA

A

Ca gluconate gel to burn (Acid binds Ca++ -> HypoCa++). Intra arterial Ca w/ Mg

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42
Q

NSM asthmatic with GERD

A

ppi 1st line then consider EGD if no improvement

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43
Q

AD syndrome assoc w/ breast, soft tissue sarcoma, ACC, brain tumors, leukemia

A

p53 Li framieni

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44
Q

Syndrome and gene associated with RCC, hemangioblastoma (retina/CNS), pheo

A

Von hippeau Linda’s (VHL gene(

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45
Q

Treatment for stage III Hidraadenitis refractory to medical tx

A

WLE w/ STSG or other tissue coverage

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46
Q

SVC 2/2 sq cell ca curative tx?

A

Radiation. If palliative can consider stent and chemo first but sq cell very radiosensitive

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47
Q

NSM w/u 8 cm leg soft tissue sarcoma after MRI

A

CNB can consider excisional bx if <5cm

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48
Q

Vit C def error in collagen synthesis?

A

Failure of proline hydroxylation (in ER) -> defective pro-a chain -> unstable collagen triple helices

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49
Q

16 F ovarian torsion w/ 6cm cyst. Tx?

A

Detorsion with ovarian cystectomy

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50
Q

landmarks, positioning thoracentesis

A

Sitting upright with needle btw spine and posterior axillary line 8th ICS (Above 10th)

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51
Q

Clustered calcifications on mammograpy

A

MCC of DCIS (linear benign vascular) THINK ducts are clustered together

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52
Q

CNB complex sclerosing lesion NSM?

A

Excisional biopsy

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53
Q

Excisional bx for atypical ductal hyperplasia with positive margins NSM?

A

No further tx

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54
Q

Meds that contribute to gynocomastia in males ?

A

Dig, thiazides, estrogens theophylline

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55
Q

Diagnostic criteria for IFB in patient with peau d orange, < 6 mo sxs

A

Need bx confirming invasive cancer, tumor invasion into dermal lymphatics not enough

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56
Q

Tx for all types of phyllodes tumor malignant? SLND?

A

WLE with at least 1 cm margin no SLND (acts like a sarcoma spreads blood)

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57
Q

Most appropriate diagnostic modality to diagnose pancreatic divisum

A

MRCP w/ secretin - visualize dorsal pancreatic duct crossing ant to CBD and draining via minor papilla w separate Ventral duct (Pathoma)

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58
Q

4 wk old with persistent jaundice. Normal HIDA. NSM?

A

Ig assay for infectious causes (TORCHES) of neonatal hepatitis. Normal HIDA r/o biliary atresia

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59
Q

12 yo w recurrent pancreatitis 2/2 pancreatic divisum tx?

A

ERCP w sphincterotomy of minor papilla

60
Q

Effect of increase PEEP (2)

A
  1. Inc aveolar recruitment -> inc FRC 2. Dec veous return, dec preload, dec LVEP, dec SV
61
Q

1 cm stable pt with stab wound left of umbilicus NSM

A

wound exploration -> + CT vs obs ….if negative d/c home

62
Q

What reflex can be present in brain death?

A

lower limb withdrawl response (No brainstem reflex allowed spinal reflexes okay)

63
Q

Ideal CPP in TBI patients?

A

Between 60-70 with ICP of <20. CPP > 70 brain edema/ARDS CPP < 50 ischemia

64
Q

what receptor does vasopressin bind?

A

V1 G coupled receptor

65
Q

Criteria for liver trn for HCC?

A

1) No extra hepatic dz or vascular involvement Meets Milan criteria one lesion less than 5 cm or up to three lesions all less than 3 cm (Note UCSF criteria more liberal total lesions have to be less than 8cm

66
Q

1 sx in 50% of pt w/ achalasia

A

Dysphagia (S+L) = functional&raquo_space; mechanical issue (not stricture, tumor); Solids > 50% & liquids 2/3 of pts

67
Q

operative step to avoid gastric band slippage?

A

insert band through a tunnel through the pars flaccida

68
Q

Diff post vagotomy diarrhea vs dumping syndrome?

A

PVG - watery diarrhea and urgency with NO relation to meals

69
Q

Tx post vagotomy diarrhea

A

1) inc fiber, dec carb and lactulose, stop caffenine 2) cholecystiramine

70
Q

Associated with chromosome 11 deletion cryptorchism, hypospadius, MR, biliateral absent iris

A

WAGR Syndrome (W= Wilms tumor)

71
Q

Surg tx for malrotation?

A

Ladds Procedure 1) evicerate bowel incise outer leaftlet to fan the mesentary

72
Q

MC type of intussception?

A

ileocolic #1 least common is ilealileal

73
Q

MCC after strictureplasties

A

bleeding 9%

74
Q

Protrusion of rectal mucosa in radial pattern

A

prolapsed internal hemmorhoids TV

75
Q

Age to begin CRC screening 35 yo m w FH 38 yo bro with 1.2 cm TV adenoma

A

38 (1st degree relavtive w adv adenoma (>1cm, HGD, villuous or TV, serrated adenoma start screening at 40 yo or age of onset of adenoma in relavtive whichever is first)

76
Q

45 yo F w/x2 < 1cm tubular adenomas w/o dysplasia colonoscopy next?

A

7-10 yrs

77
Q

Normal velcoities on Carotid Duplex U/S of ICA

A

“ICA PSV is < 125 cm/sec and plaque or intimal thickening is visible sonographically. Additional criteria include ICA/CCA PSV ratio < 2.0 and ICA EDV < 40 cm/ses

=125 cm/sec 50% stenosis (can be sx at this point), >230 > 70% stenosis “

78
Q

Triphasic waveform vs biphasic

A

Biphasic up and down stroke without flow reversal

79
Q

Preop Fistula Artery and vein sizes

A

2mm for arteries and 2.5 mm for veins

80
Q

Tx of DVT following endovenous ablation < 50%

A

EHIT (endothermic heat induced thrombosis) diff from DVT. weekly surveillance. TLOV if >50

81
Q

Most common site of atheroscerlosis?

A

Branch points. (>40% stenosis compromises vessel lumen)

82
Q

Definitive tx for aorta enteric fistula following open AAA repair?

A

Graft explanation and extra anatomical bypass

83
Q

Submucosal 3cm dumbellshaped stomach mass tx

A

GIST (c-kit, CD117) . Tx resection with grossly - margin (unless > 3cm or > 5 mitosis HPF -> Gleevac)

84
Q

80 yo F w HF intubated in ICU on pressers with fever increasing WBC with U/S showing gallbladder wall thickening and echogenic shadowing. Tx?

A

Perc Chloe tube for a calculus Chloe

85
Q

31 yo m with 1 yr painless unilateral testicular mass increasing in size past 3 mo extending to ext ring that transilluminates? Diag?

A

31 yo m with 1 yr painless unilateral testicular mass increasing in size past 3 mo extending to ext ring that transilluminates? Diag?

86
Q

Healthy 25 yo with califlower lesions around anus NSM of workup?

A

Anoscopy and Proctosigmoidoscopy to evaluate for intracolonic dz. Dont need to do full colonoscopy

87
Q

Tx for horseshoe abscess?

A

Hanlay prcoedure 3 incisions. x1 posterior midline to drain posterior (deep postanal space), x2 laterally to drain ischiorectal fossas

88
Q

Peripheral blood smear finding in patient with ITP and functioning splenic tissue?

A

Decreased platelets and normal appearing RBCs. Findgins assocaited with asplenia include heniz body, HJ body target cells etc

89
Q

ET CO2 changes with malignant HTN versus CO2 embolus

A

Malig HTN inc in CO2 2/2 inc metabolic state fever everything else CO2 embol, arrest, bronchospasm, PE all dec CO2

90
Q

Best operative tx for SMA snydrome

A

Try conservative 1st feeding tube, reglan. If fails MC operation duodenojejunostomy to bypass blockage

91
Q

Study of how organism affects the drug?

A

Pharmacokinetics (metabolism, excretion, aborption) whereas dynamics is how drug affect body ie ligand binding to receptor

92
Q

Is multifocal dz a CI to BCT w/ invasive cancer?

A

No but multifocal centric IS (in more than one quadrant of the breast)

93
Q

Surgical tx for patient with idopathic atonic ‘esophageal dysmotility w/o achalasia or stricture?

A

Partial fundoplication anterior dor or posterior toupet.

94
Q

When is partial wrap absolute C/I in patient with esophageal dysmotility?

A

Achalasia or scleroderma

95
Q

what is monoclonal abx used in melanoma?

A

Pembroluzimab (monoclonal ab that prevents downstream signaling of PD-1)

96
Q

Indications for damanage control laparotomy?

A

Hemodynamic instability Acidosis <7.2, Base deficit >15, temp <34, transfusion >12 L, refractory coagulapathy (based on lab values and clinical assesment

97
Q

Term for TP + FN / total indviduals studied

A

Prevlenace

98
Q

Anatomical landmarks for paracentesis

A

3 cm medial and superior to ASIS on LEFT, avoid right lactulose causes cecal dilation

99
Q

Uncontrolled DM with PNA hemoptysis and ischemia on bronch with broad nonseptated hyphae Diag & tx?

A

Mucomycosis (mucor and rhizous) Tx aggresive Liposomal Amphotericin B, intubation, Pulmonary resection for debridment contrast w aspergillus

100
Q

ADH acts on which receiptors in kidney to increase water reasorption?

A

V2 (two kidneys). V1 Smooth muscle vasoconstrict

101
Q

11 yo with recurrent vomiting after meals w double bubble Diag?

A

Annular pancreas (delayed presentation)

102
Q

3o yo m Colon cancer with yellow facial Papules. Bx sebaceous carincoma

A

Muir Torre Syndrome (AD variant of HNPCC/Lynch syndrome

103
Q

Better survival rate of luminal subtypes ?

A

Luminal A&raquo_space; B in terms of survival (ER, PR + HER 2 -) BETTER TO GET A’s than B’s on test

104
Q

MEN 2 what tumor marker followed Postop total thyroidectomy with CNL dissection

A

Calcitonin (From parafollicular C cells) opposes PTH used to monitor for recurrence of MTC

105
Q

Treatment for high output thoracic duct leak 2/2 malig pulm?

A

Chemo radiation if persists -> OR for pleurodesis (80% success)

106
Q

Vitamin A def?

A

Xeropthalamia (can’t cry), Rashes

107
Q

Vit E def?

A

Hemolytic anemia and neuromuscular disorders

108
Q

How to calculate Na deficit.

A

Na deficit = (desired Na - Patient Na) * TBW ; TBW = weight kg *60 males or 50% females

109
Q

Tx of UTI in pregnant pt with PCN allergy?

A

Nitrofuratonin. Bactrim is folic acid antagonist

110
Q

Chews tobacco slowly growing mucosa lower lip pedunculated 3 cm attached to mucuosa Diag and tx

A

Verrucous ca (subset of scc that pushes rather than invades looks velvety and bad but isn’t) NSM WLE with flap reconstruction (Moh’s only for cutaneous sec)

111
Q

SCC anal canal 3 cm s/p chemo radiation regressing now 1cm - LN

A

Observe if getting small f/u 6 mo anoscopy ->if persists @ f/u APR; Repeat bx if enlarging

112
Q

CDH detected on 18 week prenatal U/S NSM?

A

Fetal MRI, ECHO, genetic evaluation to confirm consider vertebral and cardiac abnormalities

113
Q

which polypossi syndrome is a subset of FAP and Lynch syndrome respectively?

A

FAP - Gardner colon polyposis, Desmoid, cranial osteomas, cutaneous lesions (epidermal inclusion cysts and lipomas); HPNCC (Lynch) subtype Muir Torre sebaceous gland tumors

114
Q

32 yo painless, solid testicular masss on U/S, NSM?

A

Radical inguinal orichectomy(remove testicle and spermatic cord through inguinal ring

115
Q

Criteria to qualify for observation of malig pedunculated polyp which was endoscopically resected? Follow up screening?

A

4 Criteria. Pedunduclated, single specimen, completely removed w/clear margins, favorable histology (pT1, grade I or II and no angiolymphatic). Follow up endoscopy q1 year

116
Q

Tx for NOMI from urosepsis?

A

Intra arterial papaverine infusion (infusion of vasodilator)

117
Q

Preop Cardiac W/u for noncardiac surgery (elective hernia 55 yo, >4 METS)?

A

No further testing need

118
Q

Drug added to Folfox regimen for poor response to chemo for nonop metastatic colon ca?

A

Cetuximab (anti EGFR tx)

119
Q

NCCN Guidelines pt w hx of adenomatous polyp + high risk feat. (serrated, HGD, SSP-d, villious or. Tubulovillous histo, bet 3-10 or >.1cm ?

A

Repeat colonoscopy in 3 years

120
Q

1cm black lesion conc for melanoma…NSM? Margins?

A

Excisional biopsy of skin and fat with 1-3 mm margins, if less than 2 cm in size (incisional/punch)

121
Q

Best tx for Hurley stage III Hidraadenitis ?

A

Extensive local excision with STSG coverage (Don’t just do I&D!)

122
Q

What melanoma pt gets SLNB?

A

All >1mm or >0.8 + high risk feats (ie mitotic rate >1mm^2 or ulceration)

123
Q

Firm Flesh covered plaques with finger like projections of spindle cells on histo?

A

DFSP (dermatofibrosarcoma protuberans)

124
Q

NSM s/p WLE of 1.2 malignant melanoma with 2 positive LN w adequate margins?

A

Observation (Don’t do completion node dissection!!! MSLT-2 trial)

125
Q

Red/purple raised, dome shaped subcu nodule w.o “rolled edge”?

A

MCC (Merle cell ca) looks like basal cell

126
Q

Lesion + for cytokeratin 20 and negative for TTF (thyroid transcription factor)?

A

MCC (Merle cell ca)

127
Q

Lesion + for cytokeratin 20 and + for TTF-1 (thyroid transcription factor)?

A

Small cell ca of lung

128
Q

W/u for palpable LN with melanoma

A

1st CNB vs FNA to confirm met -> if neg excision of node OR if pos lymphadenectomy (levels I-III) during resection

129
Q

Where do you make incision for felon finger?

A

Vertical incision over the fingertip pulp (avoid lateral neurovasc) and don’t past DIP joint or bluntly dissect septa (tendon)

130
Q

Diag test for 18 yo “double jointed with painful bump below knee?

A

CT angiogram of chest (classic Ehlers-Danos) type 5 collagen to look for aortic root aneursym

131
Q

Oozing melanoma resection risk of wound infectioin?

A

1-2% Clean However SLNB higher 5%

132
Q

LIRNEC score specificity and sensitivity for NST?

A

High specificity low sensitivity (can’t use to rule out infection)

133
Q

Stage of 5cm truncal sarcoma w/ nodal involvement no other met

A

Stage IV if any nodal involvement (diff from RP sarcomas)

134
Q

Follow up for stage I melanoma?

A

Surveillance only! (H&P 6-12 mo for 5 years)

135
Q

how to close femoral canal

A

Suturing IL to pectineal ligament using interrupted absorbable suture.

136
Q

Diagnosis nonhealing ulcer 57 yo DM obese HMB-45 positive immunochemistry?

A

Melanoma (+HMB-45, Melan-A, S-100 protein) markers….NOT DM foot ulcer!

137
Q

What sarcoma requires WLE w/ Sentinel LN biopsy if clinically node negative?

A

Rhabdomyosarcoma in peds pt

138
Q

CDH detected on 18 week prenatal U/S NSM?

A

Fetal MRI (NEXT BEST STEP), ECHO, genetic evaluation to confirm consider vertebral and cardiac abnormalities

139
Q

MCC in Hirschprung’s and best pull through anastamosis to prevent it?

A

Anastamotic stricture, end to side (rectum -> small bowel)

140
Q

Most common presenting symptom in pt’s w/ ASD?

A

Dyspnea and shortness of breath 2/2 CHF (usually in adulthood)

141
Q

NSM metastatic neuroblastoma on labs and MIBG scan?

A

Biopsy to determine N-myc status then chemo followed by radiation

142
Q

Persistent jaundice with normal HIDA NSM?

A

immunoglobulin assay for TORCHES infection

143
Q

6 wk old with persistent jaundice 2/2 biliary atresia NSM?

A

Kasai procedure heptaportalenteroenterostomy

144
Q

Indication for indomethacin tx in neonate?

A

Close persistent PDA

145
Q

Fredet-Ramstedt pyloromyotomy treats pyloric stenosis by dividing the hypertrophied pyloric muscle until what layer seen?

A

Gastric Submucosa/mucosa buldge out into “olive mass”

ABS QE (1 decks)

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